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All Journal Jurnal Anestesiologi Indonesia Journal of Anaesthesia and Pain Solo Journal of Anesthesi, Pain and Critical Care Jurnal Neuroanestesi Indonesia
Laksono, Buyung Hartiyo
Departemen Anestesiologi Dan Terapi Intensif, Fakultas Kedokteran, Universitas Brawijaya, RSUD Dr. Saiful Anwar, Malang, Indonesia
Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Education Health Professions Medicine & Pharmacology Neuroscience Nursing Public Health

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Diameter dan Indeks Inferior Vena Cava (IVC) Berkorelasi dengan Central Venous Pressure (CVP) pada Pasien Kritis yang Menggunakan Ventilasi Mekanik di Intensive Care Unit (ICU) Buyung Hartiyo Laksono; Arie Zainul Fatoni; Vilda Prasastri Yuwono; Aswoco Andyk Asmoro
JAI (Jurnal Anestesiologi Indonesia) Vol 13, No 2 (2021): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v13i2.33829

Abstract

Latar belakang: Pengukuran central venous pressure (CVP) merupakan salah satu metode guiding deresusitasi pada pasien dengan kasus tertentu. Kenaikan nilai CVP 1 mmHg dikaitkan dengan peningkatan angka kejadian acute kidney injury (AKI). Namun sebagai sebuah metode yang invasif, pemasangan CVP memiliki risiko yang perlu diperhatikan. Di sisilain, pengukuran diameter dan indeks IVC yang bermuara di atrium kanan dengan menggunakan ultrasonografi (USG) non-invasif dinilai mampu untuk memprediksi nilai CVP pada pasien. Namun beberapa penelitian hubungan antara CVP dengan diameter dan indeks IVC memberikan hasil yang kontroversial.Tujuan: Penelitian untuk mengetahui hubungan antara nilai CVP dengan diameter dan indeks IVC.Metode: Penelitian ini menggunakan metode cross-sectional pada 30 pasien yang dilakukan ventilasi mekanik dan pemasangan CVC di unit perawatan intensif. Parameter CVP, diameter minimum dan maksimum inferior vein cava (IVC mak, IVC min), distensibillity index (DI-index), dan aortacaval index (Cava/Ao index) diukur. Data dianalisis menggunakan uji korelasi pada SPPS 18.0 (p<0.05).Hasil: Didapatkan korelasi signifikan antara CVP dan semua variabel yang diuji (IVC mak, IVC min, DI-index, dan Cava/Ao index) (p<0.05), dengan korelasi terkuat antara CVP dan IVC min (R= 0,908). Korelasi bersifat positif, kecuali antara DI-index dan CVP.Kesimpulan: Parameter IVC min, IVC mak, Cava/Ao- index, dan DI-index signifikan berkorelasi kuat dengan CVP. Korelasi terjadi bersifat positif, kecuali antara DI-index dan CVP.
Perioperative Management of Subdural Hemorrhage (SDH) Trepanation Decompression with Hemophilia A Andika Satria Praniarda; Buyung Hartiyo Laksono
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 1, No 2 (2021): October 2021
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (879.454 KB) | DOI: 10.20961/soja.v1i2.54642

Abstract

Hemophilia is a serious inherited blood disease, transmitted by women, that affects mainly men and lasts for a lifetime. Hemophilia A is the most common form. If any of the factors necessary for blood clotting are absent or insufficient, the clotting mechanism is disturbed, causing insatiable bleeding. The most common cause of death in hemophilia patients is cerebral hemorrhage due to head trauma. In cases of intracranial hemorrhage, surgery should be performed immediately to obtain a better prognosis. A 17-year-old man diagnosed with a 2x4 loss of consciousness due to intracranial subdural hemorrhage (SDH) in the left frontotemporoparietal region and cerebral edema on day 4 accompanied by subfalcine herniation to the right with hemophilia A, planned trepanation decompression for SDH evacuation. The patient received 4000 units of factor VIII injection before surgery. Bleeding during surgery was 1100cc and he received a transfusion of 1940cc blood products until hemodynamically stable. In the postoperative phase, he was admitted to the ICU for 8 days, extubation was performed after the condition improved. In patient with hemophilia, evacuation of bleeding should be performed immediately, but there is a high risk of rebleeding. A recombinant factor VIII substitute should be administered immediately for the treatment of acute bleeding in patients with severe haemophilia A. Anesthetic maintenance should include reducing the risk of hypertension and tachycardia to minimize bleeding.
Delta Inferior Vena Cava Index Correlated with Mean Arterial Pressure (MAP) in Spinal Anesthesia Wiwi Jaya; Ulil Abshor; Buyung Hartiyo Laksono; Arie Zainul Fatoni
Journal of Anaesthesia and Pain Vol 2, No 2 (2021): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2021.002.02.04

Abstract

Background: Spinal anesthesia has become an alternative to general anesthesia. However, spinal anesthesia has the most common side effects including, bradycardia and hypotension. The aim of this study was to determine the relationship between changes in the inferior vena cava index (delta inferior vena cava index) to changes in mean arterial pressure in spinal anesthesia.Methods: This study was an observational pre-post test study in thirty-two patients who received spinal anesthesia. The inferior vena cava index (inferior vena cava collectibility index and caval-aorta index) was measured before and after spinal anesthesia (5 and 10 minutes after onset). Data were analyzed using the Kolmogorov Smirnov test, Shapiro-Wilk test, T-test, and correlation test with α=5%Result: There was a significant difference in mean arterial pressure (MAP), delta inferior vena cava collectibility index (D-IVC-CI), and delta caval-aorta index (D-CAo-I) before and after spinal anesthesia. D-IVC-CI and D-CAo-I are significantly correlated with MAP. The correlation between D-IVC-CI and MAP had R = -0.371 (P <0.05) at 5 minutes post-anesthesia, while D-CAo-I and MAP had R = 0.472 (P <0.05) at 10 minutes post-anesthesia. Conclusion: The delta inferior vena cava index is correlated with the mean arterial pressure (MAP) value in spinal anesthesia.
Pengaruh Penggunaan Alcohol Swab Terhadap Tingkat Kontaminasi Bakteri pada Blade Laringoskop di Kamar Operasi Sentral Rumah Sakit Saiful Anwar Buyung Hartiyo Laksono; Isngadi Isngadi; Muhammad Rizqan Khalidi
Journal of Anaesthesia and Pain Vol 1, No 1 (2020): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2020.001.01.03

Abstract

Latar belakang: Infeksi nosokomial masih menjadi masalah di dunia kesehatan dengan angka kejadian infeksi yang cukup tinggi. Salah satu penyebab tingginya infeksi nosokomial adalah penggunaan peralatan yang terkontaminasi bakteri. Laringoskop merupakan salah satu alat yang banyak mengalami kontak langsung dengan pasien pembedahan dan memiliki potensi sebagai agen pembawa kontaminan. Belum ada standard internasional maupun nasional untuk desinfeksi atau dekontaminasi laringoskop. Penelitian ini bertujuan untuk mengetahui pengaruh penggunaan teknik alcohol swab terhadap tingkat kontaminasi blade laringoskop di kamar operasi rumah sakit umum Dr. Saiful Anwar Malang.Metode: Penelitian ini merupakan penelitian eksperimental. Sampel penelitian adalah 32 buah blade laringoskop yang dibagi menjadi kelompok. Kelompok kontrol/ kelompok I (n=16) tidak diberi perlakuan alcohol swab dan kelompok perlakuan/ kelompok II (n=16) diberi perlakuan alcohol swab. Analisis bakteri dilaksanakan di Laboratorium Mikrobiologi Fakultas Kedokteran Universitas Brawijaya. Analisis data menggunakan uji One-Way ANOVA pada software SPSS 16.0. Hasil: Jumlah kontaminasi bakteri pada kelompok kontrol signifikan lebih tinggi (75%) dibandingkan kelompok perlakuan (35,5%)(p<0,05). Blade laringoskop yang mendapat perlakuan alcohol swab memiliki tingkat kontaminasi bakteri yang lebih rendah daripada blade laringoskop yang tidak mendapat perlakuan alcohol swab.Kesimpulan: Alcohol swab 70% dapat digunakan untuk memaksimalkan proses desinfeksi dengan cara menurunkan tingkat kontaminasi bakteri.
Manajemen Nyeri Akut Pasca-Kraniotomi Razi Ageng Pratama; Buyung Hartiyo Laksono; Arie Zainul Fatoni
Journal of Anaesthesia and Pain Vol 1, No 3 (2020): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2020.001.03.04

Abstract

Kraniotomi adalah sebuah prosedur operasi umum divisi bedah saraf yang melibatkan pembuatan lubang yang cukup pada tempurung kepala atau tengkorak (cranium) untuk akses optimal ke intrakranial. Nyeri pasca kraniotomi adalah komplikasi berulang dari prosedur bedah saraf dan sulit untuk dikelola. Manajemen nyeri akut sangat penting untuk menghindari terjadinya nyeri kronik serta komplikasi seperti hipertensi dan muntah, yang dapat menyebabkan peningkatan tekanan intrakranial maupun perdarahan intrakranial, outcome pasien yang tidak baik, dan perpanjangan masa rawat inap. Pemilihan obat dalam manajemen nyeri akut pasien pasca kraniotomi merupakan hal yang sangat penting dikarenakan dapat menentukan morbiditas dan mortalitas pasien.
Dextrose Prolotherapy for Occipital Neuralgia Management Taufiq Agus Siswagama; Buyung Hartiyo Laksono; Mirza Koeshardiandi
Journal of Anaesthesia and Pain Vol 2, No 3 (2021): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2021.002.03.02

Abstract

Background: Occipital neuralgia defined as a pain such as being stabbed in the skin according to the dermatomes of the greater occipital nerves (GON) and lesser occipital nerves (LON).Case: An 80-year-old male patient diagnosed with occipital neuralgia. Previously, patients were diagnosed with lung cancer six months ago and planned for follow-up chemotherapy. Patient already receive medications including paracetamol, Non-steroidal anti-inflammatory drugs (NSAIDs), minor tranquilizers, and antidepressants, but the pain still exist. Patient then scheduled to receive blocks of GON and LON-ultrasound-guided using plain lidocaine 2% and steroids dexamethasone 10 mg. Fifteen days later, patient receive perineural deep injection along with prolo-hydrodissection in GON and LON using dextrose 15% and local anesthesia lidocaine plain 2% with a volume of 3 cc each nerve.  The intervention give a positive outcomes, pain is reduced with NRS rest 0-1, NRS motion 2-3, hearing improves, and the noise in the ear disappears. The patient can sleep using a pillow. Conclusion: Block GON and LON, perineural deep injection along with prolo-hydrodissection  provides a positive outcome for occipital neuralgia pain management. This case showed an opportunity for pain specialist to develop pain intervention based on prolotherapy.  
Tatalaksana Anestesi pada Direct Clipping Aneurisma Otak Buyung Hartiyo Laksono; Nazaruddin Umar; Marsudi Rasman
Jurnal Neuroanestesi Indonesia Vol 4, No 3 (2015)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2386.28 KB) | DOI: 10.24244/jni.vol4i3.123

Abstract

Perdarahan subarachnoid (SAH) yang diakibatkan oleh pecahnya aneurisma otak menyumbang sekitar 85% dari kejadian SAH non traumatik. Insidensi sekitar 8–10 per 100.000 penduduk per tahun atau sekitar (0,008%). Rangkaian tatalaksana kasus SAH mempengaruhi outcome dari hasil terapi, mulai dari pertolongan pertama pada prehospital, transportasi, diagnosis awal, manajemen kegawatdaruratan dini, tindakan neuroradiologi intervensi ataupun pembedahan dan perawatan intensif pasca tindakan definitif. Pada laporan kasus ini, pasien wanita usia 65 tahun, berat badan 50 kg dengan diagnosa SAH hari ke 18 karena pecahnya aneurisma arteri serebri media disertai defisit neurologis ringan. Pembedahan dilakukan tindakan kraniotomi direct clipping aneurisma. Prinsip anestesi yang dilakukan adalah pemeliharaan homeostasis dan Cerebral Perfusion Pressure (CPP)/Transmural Pressure (TMP) yang efektif, tindakan pencegahan peningkatan tekanan intrakranial (Intracranial Pressure-ICP), pembengkakan otak dan manajemen vasospasme serebral. Operasi berjalan 6 jam dan dilakukan rapid emergence. Outcome pembedahan sesuai yang diharapkan. Anestesi mempunyai peranan yang sangat penting dalam manajemen secara keseluruhan pada pasien ini untuk memberikan manajemen proteksi otak yang maksimal selama pembedahan sehingga memperoleh hasil akhir pembedahan yang sukses. Anesthetic Management in Direct Clipping Cerebral AneurysmaSubarachnoid hemorrhage (SAH) caused by rupture of a brain aneurysm accounts for about 85% of the incidence of non-traumatic SAH. The incidence is approximately 8-10 per 100,000 populations per year, or about (0.008%). The management of SAH affects the outcome, ranging from first aid in Prehospital, transportation, early diagnosis, early emergency management, neuroradiology action or surgical interventions and intensive therapy after definitive care. In this case report, a 65 years old female, 50 kgs, diagnosised with SAH day 18 due to middle cerebral artery aneurysm rupture with mild neurological deficits. Craniotomy was performed using direct aneurysm clipping. The anesthesia principle is to maintain adequate homeostasis and effective Cerebral Perfusion Pressure (CPP)/Transmural Pressure (TMP), preventing increase in ICP, brain swelling and management of cerebral vasospasm. The operation was done in 6 hours with rapid emergence. The outcome of surgery was as expected. Anesthesia has a very important role in the overall management of these patients to provide optimal brain protection management during surgery in obtaining successful outcome.
Gangguan Natrium pada Pasien Bedah Saraf Buyung Hartiyo Laksono; Bambang J. Oetoro; Sri Rahardjo; Siti Chasnak Saleh
Jurnal Neuroanestesi Indonesia Vol 3, No 1 (2014)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2375.627 KB) | DOI: 10.24244/jni.vol3i1.132

Abstract

Gangguan pada susunan saraf pusat (SSP) akan mengakibatkan gangguan pada fungsi axis hipotalamus hipofise, yang akan menyebabkan gangguan pada keseimbangan cairan dan elektrolit. Selain karena lesi neurologis primer yang terjadi pada SSP, penyebab kelainan elektrolit ini juga disebabkan oleh tindakan pembedahan atau iatrogenik, tindakan perawatan pascabedah di intensive care unit (ICU) akibat dari tindakan medis, misalnya obat-obatan dan pemberian cairan intravena, pemberian diuretik, pemberian steroid dan mannitol. Gangguan elektrolit paling banyak terjadi pada natrium. Dua kondisi dengan klinis hiponatremi adalah SIADH dan CSWS, yang penataksanaan keduanya sangat berbeda. Hampir 62% pasien bedah saraf dengan hiponatremia (kadar natrium 135 mmol/L) disebabkan oleh SIADH, sedangkan sisanya 16,6% karena penggunaan obat-obatan dan 4,8% karena CSWS. Gangguan natrium dengan gambaran klinis hipernatremi adalah diabetes insipidus (DI). DI terjadi sekitar 3,8 % pada pasien bedah saraf. Kondisi keseimbangan cairan dan elektrolit pada pasien dengan kelainan SSP yang dilakukan tindakan anestesi dan operasi merupakan tantangan khusus bagi dokter anestesi dan intensivist. Pasien pasien bedah saraf biasanya mendapatkan terapi diuretik sebagai salah satu manajemen edema otak dan untuk mengurangi tekanan intrakranial. Di sisi lain efek diuresis dari lesi pada otak dan penggunaan teknik hipotermi juga akan menambah kondisi diuresis pada pasien bedah saraf. Efek diuresis yang berlebihan menyebabkan kehilangan natrium. Sodium Disturbance in Neurosurgical PatientDisturbance of the central nerve system (CNS) will lead to interference with the function of the hypothalamus pituitary axis and will cause disruption of fluids and electrolytes balance as well. In addition to its primary neurological lesions occurring in the CNS, the cause of electrolyte abnormalities are also due to surgical procedure or iatrogenic, postoperative medical treatment in ICU such as administration of drugs and intravenous fluids, diuretics, steroids and mannitol. The most frequent electrolyte disorder is sodium. Two clinical conditions related to hyponatremia are SIADH and CSWS which the management can be totally different, respectively. Nearly 62% of neurosurgical patients with hyponatremia (sodium levels 135 mmol / L) is caused by SIADH, while the remaining 16.6% patient is due to the use of drugs and 4.8% patient is due to CSWS. Sodium disorder clinically referred to as hypernatremia is diabetes insipidus (DI). DI occurs around 3.8% in neurosurgical patients. The condition of fluid and electrolyte balance in patients with CNS disorders undergoing anesthesia and surgery is a particular challenge for anesthesiologists and intensivists. The patients usually receive diuretic therapy to manage brain edema and to reduce intracranial pressure. On the other hand, diuresis effects due to brain lesions and the use of hypothermia technique will also increase diuresis condition in neurosurgical patients. Excessive diuresis effect will cause loss of sodium.
Social Service of Pain Management for Patients Unresponsive to Conservative Treatment Ristiawan Muji Laksono; Taufiq Agus Siswagama; Buyung Hartiyo Laksono; Aswoco Andyk Asmoro; Priscilla Tulong; Emilia Tiara Shantikaratri; Haffidz Wahyu Aji; Yudhistira Yuliandra; Dadik Prasetya Hutama; Candra Aditiarso
Journal of Anaesthesia and Pain Vol 3, No 3 (2022): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2022.003.03.01

Abstract

Pain is one of the most common complain encountered in outpatient clinic. Inadequate pain management has been widely reported. As an anesthesiologist and pain physician, we perform a social service of pain management for patients unresponsive to conservative treatment. The social service  was held from April - June 2022. We enrolled thirty-two patients from other physician reference and Primary Health Care in several districts around Malang city to come to Brawijaya University Hospital with the age range of 30-80 years old. The pain interventions given to the participants mainly include prolotherapy, pulsed radiofrequency (PRF), and others. The pain measurement of the patients were assessed with Numerical Rating Scale (NRS), pre and post-intervention. The social service is performed on 32 patients (male 34,37%, female 65.62%), majority aged 60 years od and older (34.37%) with low back pain become the major complaint (43.75%). The majority of patients receive prolotherapy (68%). The mean NRS decrease from 6.19 ± 0.18 (before treatment) to 2.69 ± 0.10 (after treatment). After this social service, most patients (96.875%) have obtained better pain control after given pain interventions. 
Chula Formula is recommended in Estimating the Length of Tracheal Tube Insertion in Patients Receiving Mechanical Ventilation in Intensive Care Units in the Absence of Chest X-Ray Laksono, Buyung Hartiyo; Hartono, Ruddi; Tamam, Abdul Rasyid; Jaya, Wiwi
Journal of Anaesthesia and Pain Vol 4, No 2 (2023): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2023.004.02.01

Abstract

Background: Chest X-Ray (CXR) is one of the most effective ways of confirming the length of the tracheal tube (TT) insertion. However, some intensive care unit in developing countries has no sufficient facilities. This study aims to evaluate the accuracy of TT length insertion using the Chula formula and Colombian formula in patients receiving mechanical ventilation in intensive care units.Methods: This study is a comparative observational study of 50 adults in the Intensive care unit, divided into two groups. Group A used the Chula formula for TT length insertion (n= 25) and Group B used the Colombian formula (n= 25). The TT length insertion accuracy was evaluated using radiological parameters. Statistical analysis used: Data were analyzed statistically using the T-test and Chi-square test.Result: The Chula formula is significantly more precise than the Colombian formula in estimating the length of TT insertion based on the radiographic parameters of the TT length insertion right midway between the medial tip of the clavicle and TT located in the T3 or T4 vertebrae (p <0.05), but not significantly different in the two other parameters.Conclusion: Both the Chula formula and the Colombian formula can estimate the length of TT insertion in adult patients. However, the Chula formula is more recommended in the length of TT insertion and benefit in the ICU with insufficient CXR.
Co-Authors Adipurna, Resa Putra Aditiarso, Candra Andika Satria Praniarda Arie Zainul Fatoni Aswoco Andyk Asmoro Aswoco Andyk Asmoro Bambang J. Oetoro Cahyanti G, Ramadina Putri Candra Aditiarso Dadik Prasetya Hutama Eko Nofiyanto Emilia Tiara Shantikaratri Haffidz Wahyu Aji Isngadi Isngadi Isngadi, M. Isngadi, M. Marsudi Rasman Mirza Koeshardiandi Muhammad Rizqan Khalidi Nazaruddin Umar Nurul Huda Oetoro, Bambang J. Pertiwi, Previasari Zahra Praniarda, Andika Satria Priscilla Tulong Putu Pramana Suarjaya Rasman, Marsudi Razi Ageng Pratama Ristiawan Muji Laksono Ruddi Hartono Rusly, Andri Saleh, Siti Chasnak Saleh, Siti Chasnak Saputro, Ramadhan Siti Chasnak Saleh Sri Rahardjo Sri Rahardjo Subagyo, Houdini Pradanawan Tamam, Abdul Rasyid Tatang Bisri Taufiq Agus Siswagama Taufiq Agus Siswagama Ulil Abshor Umar, Nazaruddin Vilda Prasastri Yuwono Wiwi Jaya Wiwi Jaya Yudhistira Yuliandra Yudi Hadinata